NPIMap

Organization Active NPI

Willie Dean

  • Exclusive Provider Organization
  • Modesto, CA
National Provider Identifier
1831309848
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
VN128313 Issued in CA
Legal business name
WILLIE DEAN
Practice address
1012 Raube CT
Modesto, CA 95351-2417
Phone
(209) 544-9377
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Willie Ruth DeanNPI 1669682944
Title
LVN
Phone
(209) 688-7720

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X VN128313 CA Primary

Addresses

Primary practice location

1012 Raube CT
Modesto, CA 95351-2417

Mailing address

5288 Barbados Cir
Stockton, CA 95210-6605
Phone (209) 688-7720

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831309848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5288 BARBADOS CIR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106605",
            "telephone_number": "209-688-7720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 RAUBE CT",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953512417",
            "telephone_number": "209-544-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIE DEAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "LVN",
        "authorized_official_telephone_number": "209-688-7720"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "CA",
            "license": "VN128313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.